Urology Coding Alert

Bonus: Handle all the latest coding edits with this
comprehensive rundown Just when you've got all the new CPT Codes and the January edition of the National Correct Coding Initiative edits under your belt, here comes round two of the NCCI Edits .

Good news: We've done the work for you. Here is a rundown of the most important additions and deletions in version 13.1, which took effect on April 1. Skip Modifier 59 for 52320, 52330 and 52341-52354  CMS has removed the bundling of 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) into 52351-52354 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy ...) retroactively to Jan. 1 of this year, according to the edits now on the CMS Web site (www.cms.hhs.gov/
NationalCorrectCodInitEd/NCCIEP). You can now submit 52332 with these codes to Medicare without appending modifier 59 (Distinct procedural service), says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.
 
"This will help providers from hitting utilization outliers for modifier 59 use, which can cause educational letters and audits if used too much," Hause adds.

NCCI version 13.1 also deletes the bundles between 52332 and 52320 (Cystourethroscopy [including ureteral catheterization]; with removal of ureteral calculus) and 52330 (... with manipulation, without removal of ureteral calculus).

Caution: Check with your other non-Medicare payers before eliminating modifier 59 on claims that have 52332 billed with 52320, 52330 and 52351-52354. Other carriers "are notorious for implementing new edits as they are added by CMS, but neglect to remove them when CMS does so," Hause says. You may need to continue to use modifier 59 on 52332 for commercial payers.

Tip: If you would like, you can append modifier 51 (Multiple procedures) when you report 52332 with 52351-52355 to indicate that the urologist performed the two procedures during the same operative session, but it is not required for Medicare claims.

Watch New Urogynecology Bundlings You can no longer bill a female pelvic examination under anesthesia with a cystoscopic examination. NCCI 13.1 bundles 57410 (Female pelvic examination under anesthesia) into cystoscopy codes 52000-52400 and also into codes 57283 (Colpopexy, vaginal; intraperitoneal approach [uterosacral, levator myorrhaphy]) and 57295 (Revision [including removal] of prosthetic vaginal graft; vaginal approach).

You cannot overcome these edits with any modifier, because they have a modifier indicator of "0," says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook.

How it works: A modifier indicator of "0" means that you cannot bypass or break an edit pair with any modifier. A "1" modifier indicator means it may be appropriate to "unbundle" the codes using a modifier when appropriate (for instance, different site, separate encounter).
 Several codes are [...]